The letter by Parzeller, Zedler, and Verhoff touches on central questions, even though only some of their comments point in the right direction.
Medically, the facts are clear: a patient who develops irreversible, total loss of brain function or has died subsequent to brain death requires intensive medical care until a final decision (organ donation, minimizing intensive care measures) has been made and implemented. Our article (1) aims to support intensive care doctors in caring for such patients; the need for further studies is evident. Clear and thoughtful legal regulations of the prerequisites and limitations of organ-protective intensive therapy is desirable; in Switzerland, such regulations at least exist as consensus-based and legally approved standards of the Swiss Academy of Medical Sciences (2).
The legal admissibility of organ-protective intensive care in Germany follows the general principles of medical law. In spite of the fundamental problem that patients’ advance directives/living wills and declarations on organ donation are often not consistent with one another, some forms succeed in achieving satisfactory consistency. If a patient’s advance directive says that the desire for limiting intensive care measures at the end of life should not make impossible the donation of organs, this is a satisfactory basis on which to presume the patient’s consent to limited organ-protective measures (3, 4). Such a declaration also readily satisfies the requirements of the German Federal Court of Justice in terms of the concreteness of the decision in a patient’s advance directive/living will.
The letter’s authors are correct that information on organ donation in Germany mostly dismiss the topic of organ-protective intensive care, rather than tackling organ donation including organ-protective measures candidly and transparently as a partial aspect of patient autonomy at the end of life. Indeed, it is the intention of our article to remedy this state of affairs.
On behalf of the authors
Prof. Dr. med. Hartmut H.-J. Schmidt
Klinik für Transplantationsmedizin, Universitätsklinikum Münster
Prof. Dr. jur. Thomas Gutmann
Lehrstuhl für Bürgerliches Recht, Rechtsphilosophie und Medizinrecht
Westfälische Wilhelms-Universität Münster
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.
|1.||Hahnenkamp K, Böhler K, Wolters H, Wiebe K, Schneider D, Schmidt HHJ: Organ-protective intensive care in organ donors. Dtsch Arztebl Int 2016; 113: 552–8 VOLLTEXT|
|2.||Schweizerische Akademie der Medizinischen Wissenschaften: Feststellung des Todes mit Bezug auf Organtransplantationen. Medizin-ethische Richtlinien vom 24. Mai 2011, www.samw.ch/de/Publikationen/Richtlinien.html.|
|3.||Schöne-Seifert B, Prien T, Rellensmann G, Roeder N, Schmidt H: Behandlung potenzieller Organspender im Präfinalstadium. Dtsch Arztebl 2011; 108: A 2080–6 VOLLTEXT|
|4.||Bundesärztekammer: Arbeitspapier zum Verhältnis von Patientenverfügung und Organspendeerklärung. Dtsch Arztebl 2013; 110: A-572 VOLLTEXT|